DYSMENORRHEA (MENSTRUAL CRAMPS)

Menstruation is a normal monthly occurrence for women in their reproductive age where the body sheds the lining of the uterus (womb) via the vaginal as menstrual blood. This shedding is assisted by a host of hormones among which is ‘prostaglandins’

Dysmenorrhea (Menstrual cramps) are cramping or throbbing pains felt in the lower abdomen, lower back and sometime inner thigh during menstruation.

This Pain can be so discomforting in some women to the extent of making them feel totally miserable.

It’s a common presentation among ladies below the age of 30 years, however may occur in older women.

It can be experienced before, during or immediately after the menstrual flow.

TYPES
Primary Dysmenorrhea: This is menstrual pain occurring in the absence of a uterine disease: usually starting within 6 month of a girl’s first menstruation; last 48-72 hours and respond to common analgesic treatment.

Secondary Dysmenorrhea: Menstrual pain occurring due to presence of a uterine disease. These diseases includes; Pelvic inflammatory Disease (PID), Uterine fibroid, Endometriosis, Adenomyosis, etc.
Secondary Dysmenorrhea usually begins in 20-30 years of age, after a relatively painless menses in the past; occurs with heavy or irregular period and may be accompanied by painful intercourse, Infertility or Vaginal discharge.

Symptoms of Dysmenorrhea 
Symptoms of dysmenorrhea includes; Crampy low abdominal pain, throbbing low back pain, nausea, tiredness, bloating and in some cases vomiting may ensue.

Investigation: No investigation is required in the case of primary dysmenorrhea, however you may be required to do ultra-sound scan and other investigation to rule out secondary causes

TREATMENT.

Treatment of dysmenorrhea include, Life Style changes, dietary modifications, Non Pharmacological therapy, Pharmacotherapy and sometimes surgical intervention may be required

Life Style and dietary Management

• Avoid anxiety and stress during your menses. Ensure adequate rest and sleep
• Loss weight if overweight or obese
• Regular Exercises: exercise release endorphins which serves as ‘natural morphine’. Pelvic Exercise also improves blood flow to the pelvis and uterus
• Massage your abdomen and Lower back
• Avoid tight dresses that can make you feel bloated
• Avoid Low fat diet especially vegetable fats
• Avoid Red meats: red meat are rich in arachidonic acid which help produce anti-inflammatory prostaglandins, the main hormone responsible for the uterine cramps
• Avoid caffeinated drinks: caffeine cause vasoconstriction thus poor blood supply to the uterus
• Avoid alcohol
• Reduce consumption of refined sugars as it produces insulin which results in production of prostaglandins
• Avoid salty diet: this can cause water retention and bloating especially in obese ladies

Diet Recommendation

• Liberal water intake to ensure proper hydration
• Eat food containing Calcium: take at least 2 glasses of milk or yogurt: calcium help to maintain uterine  tone thus decrease cramp. Calcium supplement can also be taken
• Eat food containing magnesium: magnesium help in the absorption of calcium
• Unripe Pawpaw: contain the enzyme papain which regulate and ease menstrual flow
• Carrot Juice or Honey and Aloe Vera: ease flow and reduce menstrual flow
• Green Vegetables: good source of Calcium and magnesium
• Sesame seeds (In Hausa Ridi): start eating 2-3 before menses. This also ease and reduce menstrual flow
• Ginger: Boil and pound the ginger. Then add little Honey to sweetened. Helps to reduce the pain
• Flax seed also help to ease flow and reduce pain

Non Pharmacological Therapy

• Take a Hot sitz bath
• Use of Hot water bottle to massage the lower abdomen
• Hypnosis and diversional therapy     

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PHARMACOTHERAPHY & SURGERY

·         Dysmenorrhea is managed with most NSAIDS (Non-Steroidal Anti-inflammatory drugs) like Ibuprofen and Piroxicam. Other drugs used are birth-control pills and other forms of hormonal birth control such as patch, vaginal ring, injection, hormone-releasing intrauterine device and contraceptive implant.

·         Surgical intervention is required in secondary cause of dysmenorrhea, e.g. removal of a fibroid.
Another surgical approach involve cutting or destroying the uterine nerves, which prevents the transmission of pain signals. However, this surgery has been shown not to provide long-term relief of pain and  may be associated with complications.

REMEMBER

Dysmenorrhea is better managed by a General practitioner or a Gynecologist (if required)

Certain red flags including new onset of pain, unremitting pain, fever and vaginal discharge are reason to seek immediate medical attention as these are usually associated with secondary dysmenorrhea